What can intracoronary pressure measurements tell us about flow reserve? : pressure-bounded coronary flow reserve and example application to the randomized DEFER trial

F.M. Zimmermann, N.H.J. Pijls, B. De Bruyne, G.J.W. Bech, P. van Schaardenburgh, R.L. Kirkeeide, K.L. Gould, N.P. Johnson

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Scopus)

Abstract

Objective: We propose a novel technique called pressure-bounded coronary flow reserve (pb-CFR) and demonstrate its application to the randomized DEFER trial. Background: Intracoronary flow reserve assessment remains underutilized relative to pressure measurements partly due to less robust tools. Methods: While rest and hyperemic intracoronary pressure measurements cannot quantify CFR exactly, they do provide upper and lower bounds. We validated pb-CFR invasively against traditional CFR, then applied it to high fractional flow reserve (FFR ≥ 0.75) lesions in DEFER randomized to revascularization or medical therapy. Results: pb-CFR showed an 84.4% accuracy to predict invasive CFR < 2 or CFR ≥ 2 in 107 lesions. In its proof of concept application to DEFER lesions with FFR ≥ 0.75, the 28 with pb-CFR < 2 compared to 28 with pb-CFR ≥ 2 had a non-significant reduction in freedom from angina (61% vs. 71% at 5 years, P = 0.57) and a non-significantly higher rate of major adverse cardiac events (MACE, 25% vs. 15%, P = 0.34). Lesions with FFR ≥ 0.75 but pb-CFR < 2 showed no difference in freedom from angina (61% vs. 50%, P = 0.54) or MACE (25% vs. 38%, P = 0.27) between the 28 randomized to medical therapy and the 16 randomized to revascularization. Conclusions: pb-CFR offers a new method for studying FFR/CFR discordances using regular pressure wire measurements. As an example application, DEFER suggested that low pb-CFR with high FFR may be a risk marker for more angina and worse outcomes, but that this risk cannot be modified by revascularization.

Original languageEnglish
Pages (from-to)917-925
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume90
Issue number6
DOIs
Publication statusPublished - 15 Nov 2017

Keywords

  • coronary flow reserve
  • fractional flow reserve
  • percutaneous coronary intervention
  • Arterial Pressure/physiology
  • Coronary Artery Disease/physiopathology
  • Animals
  • Fractional Flow Reserve, Myocardial/physiology
  • Blood Flow Velocity/physiology
  • Humans
  • Randomized Controlled Trials as Topic/methods
  • Coronary Vessels/physiopathology

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